Lihong Bao

Fear of pain (FOP) often leads to activity avoidance, hindering recovery after thoracic surgery. We proposed the concept of “Threat Prioritization”—the cognitive weighing of activity-induced pain against inactivity-induced complications. This study investigated whether prioritizing complication risks over pain is associated with greater engagement in postoperative activities and a subsequent reduction in FOP. In this prospective cohort study, 121 patients undergoing thoracoscopic lung surgery were enrolled. FOP (Fear of Pain Questionnaire-9) and cough strength (Semi-Quantitative Cough Strength Score, SCSS) were assessed on postoperative days (POD) 1 and 3. Therapeutic ambulation episodes (POD1–3) were recorded. On POD3, patients were categorized as “Complication-Focused” or “Pain-Focused” based on their self-reported primary concern during recovery. Multiple linear regression was used to identify predictors of FOP reduction. Complication-Focused patients ( n = 45) showed significantly stronger cough on POD3 (Median SCSS: 4.00 vs. 2.50, p < 0.001) and higher distribution of ambulation episodes (Median: 4.00 vs. 4.00, p = 0.003) compared to Pain-Focused patients ( n = 76). Postoperative air leak rates were comparable between groups (20.0% vs. 19.7%, p = 1.000). Regression analysis (Adjusted R ² = 0.433) showed that greater FOP reduction was associated with higher ambulation counts (B = -1.25, p < 0.001). Conversely, activity-linked breakthrough pain was associated with attenuated fear reduction (B = 5.31, p < 0.001). Changes in physiological pain intensity were not significantly associated with FOP reduction ( p = 0.964). Age, sex, and surgical extent were included in the model a priori but were not significant predictors (all p > 0.05). A mindset prioritizing complication risks over pain is associated with increased engagement in essential recovery activities without increasing observed air leak rates. Postoperative FOP reduction appears to be driven by behavioral engagement rather than physiological pain relief alone. These findings suggest that perioperative interventions targeting threat prioritization may facilitate functional recovery.

Background: The fear of pain (FOP) and fear avoidance belief (FAB) play a crucial role in the occurrence and development of chronic pain. However, the dynamics of these factors in postsurgical pain appear to differ, with the FOP often learned from others rather than directly caused by painful experiences. Psychological resilience refers to an individual’s capacity to adapt effectively to adversity, challenges, and threats, and may play a significant role in overcoming the FOP and avoidance behavior. Objective: The aim of this study was to investigate the role of psychological resilience in overcoming the FOP and avoidance behavior among surgical patients undergoing lung surgery. Methods: Participants were recruited at the Wuhan Union Hospital. Psychological resilience was measured using the Connor-Davidson Resilience Scale. The FOP was assessed using the simplified Chinese version of the Fear of Pain-9 items. The FAB was measured using the Physical Activity subscale of the Fear-Avoidance Beliefs Questionnaire. Activity recovery was assessed through questions related to social activities and household responsibilities. The adaptive least absolute shrinkage and selection operator (Lasso) regression analysis under nested cross-validation was used to identify key factors affecting postoperative FOP and activity recovery. Results: A total of 144 participants were included in the final analysis. The results showed that preoperative FOP (coefficient=8.620) and FAB (coefficient=8.560) were mainly positively correlated with postoperative FOP, while psychological resilience (coefficient=−5.822) and age (coefficient=−2.853) were negatively correlated with it. These average R² of these models was 73% (SD 6%). Psychological resilience was the most important factor in predicting activity recovery, and these models obtained an average accuracy of 0.820 (SD 0.024) and an average area under the curve of 0.926 (SD 0.044). Conclusions: Psychological resilience was negatively associated with the postoperative FOP and positively with activity recovery in patients who underwent lung surgery. Patients with higher resilience are more likely to cope effectively with postsurgical pain and recover activities sooner. These findings highlight the importance of assessing and potentially enhancing psychological resilience in the perioperative period to improve postoperative outcomes.

Andai therapy is a traditional therapy combining body, mind, and language with Mongolian characteristics. In the form of singing and dancing, it is widely popular among people of all ages in Mongolian areas of Inner Mongolia. According to Mongolian medicine, Heyi is one of the three elements of human body, and it can maintain life activities, promote blood circulation, and improve the functions of the sensory and mental consciousness. Andai therapy stimulates the whole body nerves and Heyi through music and dance, improves Heyi and blood operation, strengthens physique, improves immunity, effectively promotes physical and mental health, and plays a role in preventing and treating diseases. Objective. In this study, gas chromatography-mass spectrometry (GC-MS) was used to explore the mechanism of Andai therapy, so as to provide a new research direction for taking targeted prevention and treatment measures for diseases. Methods. Using gas chromatography-mass spectrometry (GC-MS) on all its cases baseline plasma to the targeted metabonomics testing, the differential metabolites of the experimental group (receiving Andai therapy) and control group (without receiving Andai therapy), analysis-related metabolite function, and screening of metabolites and related pathways through adjusting mechanism to explore the related factors are compared, to study the mechanism of the influence of Mongolian medical Andai therapy on the metabolism of different healthy people. Results. The differences in metabolic numbers between the experimental group and the control group are 114, such as cyclohexylamine chlorinated acid, 2,4-2 aminobutyric acid bitter almond alcohol, l-methyl inosine, 2-picolinate, and 2-hydroxy-2-glutaric acid metabolite content of the control group that are significantly higher than the experimental group, experimental groups other substance content is significantly higher than that of the control group, and two groups metabolite content was obviously different. The number of differential metabolites between the female experimental group and the female control group was 119, and the number of differential metabolites between the male experimental group and the male control group was 48.